Do I need to have blood tests to diagnose menopause?

The current UK guidelines state that if you are over the age of 45 and showing typical symptoms, then blood tests are not required to diagnose the menopause or perimenopause.

Blood tests can be notoriously unreliable. It is possible to have completely normal blood results but extreme symptoms, and vice versa. This is because blood tests are just a snapshot of time and hormone levels vary enormously from person to person.

Before the age of 45, blood tests are recommended to diagnose menopause. This is normally to exclude other causes of symptoms, and often a bank of bloods will be taken (including thyroid function,vitamin D and hormone levels).

We look at follicle stimulating hormone (FSH) and oestradiol in particular. FSH levels are typically high in menopause and oestradiol levels typically low (but not always). If your bloods are normal, we may well offer treatment to see if this improves symptoms.

If you are younger (under 40) you may be required to have more extensive blood tests, such as antibody tests, chromosome tests plus screening with bone scans.

Do I need blood tests to monitor hormone replacement?

If you are doing well on HRT and your symptoms improve, there is no need for further monitoring of bloods.

If you feel like testosterone may be indicated (see our testosterone pages for more information) then it is important to check total testosterone and SHBG baseline levels prior to starting and as part of ongoing monitoring. This is as per British Menopause Society guidelines.

There are no guidelines regarding oestrogen replacement, but we repeatedly see women on relatively high doses of transdermal oestrogen who remain symptomatic. Levels can show if their oestradiol levels remain low and monitoring oestradiol levels can be useful in these cases.

If symptoms persist and this is not what is expected clinically, blood tests may be recommended to look for other underlying causes.